Objective and importance: Cerebellar pilocytic astrocytomas are common benign tumours of childhood and mostly easy to treat because of their location and conformation. Nevertheless, unpredictable recurrence as well as the lack of features to predict the rare malignant changes after first removal, still represent a challenging problem.
Clinical presentation: A 54 years old man presented with a recurrence of a cerebellar pilocytic astrocytoma 45 years after complete removal.
Intervention: Gross total resection was performed. The pathological examination confirmed the same histological pattern as the first tumour.
Discussion: Current opinions about management and recurrence of pilocytic astrocytomas are discussed with a review of the literature.